Provider Demographics
NPI:1306492152
Name:HERNANDEZ PEREZ, YANEISY (RBT)
Entity type:Individual
Prefix:
First Name:YANEISY
Middle Name:
Last Name:HERNANDEZ PEREZ
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:YABEHERNAN@YAHOO.COM
Mailing Address - Street 2:510 NW 24 AVE
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125
Mailing Address - Country:US
Mailing Address - Phone:786-603-4056
Mailing Address - Fax:
Practice Address - Street 1:49 NW 17TH ST
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-3210
Practice Address - Country:US
Practice Address - Phone:786-305-4700
Practice Address - Fax:786-349-4862
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-16
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty